HomeMy WebLinkAboutMINUTES - 09122006 - C.113 TO: BOARD OF SUPERVISORS Contra
FROM: WILLIAM B. WALKER, M.D.
- ;
CostaHealth Services Director
DATE: 1 August 2, 2006 °°s;9 '�~~�o County
SUBJECT: Approval of Contra Costa Health Plan's Quality Management 2006 Annual .
Work Plan I
SPECIFIC REQUI EST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
Approve t 1 e attached document, which contains Contra Costa Health Plan's Quality Management
Program, including the Quality Management Program Description, the Annual Work Plan, and the 2005
Program Evaluation.
BACKGROUND:
Contra Costa Health Plan is required by state law and regulation to have a written Quality Management
Program and Plan approved by its governing body every year. CCHP has been operating under a Board
of Supervisors' approved Quality Management Program and Plan since 1997. The state Department of
Health Services requires that CCHP submit a new Quality Management Program and Plan every year to
involve thel Board of Supervisors, as the governing body, directly in the Quality Management process.
The Quality Management Program Description describes the goals, objectives, and activities of the
Quality Management Program. It also'contains the 2006 Annual Quality Management Work Plan, which
describes the quality improvement activities CCHP expects to develop and implement in 2006. As part of
the 2006 Work Plan, CCHP will perform focused review studies required by the state Department of
Health Se vices as part of the Local Initiative program. The 2005 Program Evaluation reflects the status
of the initiatives proposed in the 2005 Quality Management Work Plan.
The Quality Management Program, the 2006 Annual Work Plan, and the 2005 Program Evaluation have
been reviewed and approved by:
• T I e Contra Costa Health Plan Quality Council
• T I e Contra Costa Health Plan Managed Care Commission
• The Joint Conference Committee
FISCAL IMPACT:
None
ATTACHMENTS:
Quality Management Program Description for 2006, Annual Quality Management Work Plan for 2006,
and Quality Management Program Evaluation for 2005
CONTINUED ON ATTACHMENT: X YES SIGNATURE:----------
IGNATURE: /Q
---------------------7--------------------------------=----------------------------------------------------------------------
i/RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
✓APPROVE OTHER
SIGNATURE(S):
ACTION OF B .R ONSo02* /;L 0-a04 APPROVE AS RECOMMENDED Z O R
b
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE
AND CORRECT COPY OF AN ACTION TAKEN
UNANIMOUS(ABSENT h O-A ) AND ENTERED ON THE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE
AYES: NOES: SHOWN.
ABSENT: I ABSTAIN:
ATTESTED /J�—,Q/AQ 2aa4;
CONTACT: Ken Tilly,CCHP 313-6498 JOHN CULLEN,CORIAK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
CC: Giselle Bauge,CCHP
Ken Tilly,CCHP
BYJ',,",��,&__PEPUTY
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CONTRA COSTA
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HEALTH PLAN
A Division of Contra Costa Health Services
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QualitManagement
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PrograM Description 2006
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QM Program Description 2006 Page 1 of 22
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Quality Management Program Description 2006....................... 3
Introduction................... ...................................................................................... 3
Mission................................................................................................................. 3
Purpose................................................................................................................. 3
Scope.............................I...................................................................................... 3
Objectives...................... ...................................................................................... 3
Authority And Responsibility 4
The Contra Costa County Board of Supervisors..................................................4
TheQuality Council...... ...................................................................................... 5
MedicalDirector...........J...................................................................................... 5
Clinical Operations Officer.................................................................................. 6
Director of Quality Management......................................................................... 7
Quality Management Program Activities................................... 7
QM Program Documents ..................................................................................... 8
QMDelegation..................................................................................................... 7
Quality Improvement Initiatives.......................................................................... 8
Preventive Health and Clinical Practice Guidelines............................................ 8
Annual QM Program Evaluation......................................................................... 8
Coordination of CCHP QM Program Activities......................... 8
Credentialing.................I...................................................................................... 9
Member Grievance Process.................................................................................. 9
Utilization Management Program........................................................................ 9
Telephone Triage Program................................................................................... 9
Cooperative Care Management Program............................................................. 9
Health Education Program................................................................................... 9
DisciplinaryAction............................................................................................ 10
Safety Improvement Activities .......................................................................... 10
Confidentiality ................................................................................................... 10
Conflict Of Interest 10
QM Organization Chart......................................................................... 11
QM Committee Structure.................................................................... 12
Board of Supervisors (AOS)............................................................................. 12
Joint Conference Committee (JCC).................................................................. 13
Health Plan Coordinating Committee (HPCC).................................................. 14
The Quality Council (QC).................................................................................. 15
Credentialing Committee................................................................................... 17
AppealsCommittee............................................................................................ 18
Pharmacy And Therapeutics Committee ........................................................... 19
Managed Care Commission MCC ....... . ..............................
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Managed Care Commission (MCC) Executive Committee............................... 20
Approved by Quality Council:........................................................................... 22
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'Approved by the Managed Care Commission:.................................................. 22
Approved by the Joint Conference Committee.................................................. 22
Approvedby the BOS........................................................................................ 22
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QM Program Description 2006 Page 2 of 22
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QUALITY MANAGEMENT PROGRAM DESCRIPTION 2006
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Contra Costa Health Plan (CCHP) is the Contra Costa County operated Health
INTRODUCTION Maintenance Organization (HMO), the first Federally-qualified HMO in the
i country operated by local government. CCHP contracts with individual
providers, Contra Costa Regional Medical Center and Health Centers
(CCRMC&HC)I and Kaiser Permanente to arrange comprehensive health care
services. I
CCHP providesihealth care for public and private employee groups, private
individuals, Medi-Cal and Medicare beneficiaries, and low-income county
residents. CCHP's overall commitment is serving the County's most vulnerable
populations.
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MISSION The goal of CCHP's Quality Management Program (QMP) is to ensure that
quality, appropriate health care and related services meet or exceed members'
and other customers' expectations. The QMP mission is carried out in
accordance with CCHP's organizational mission to provide affordable, high
quality, accessible health care with integrity and compassion to all that use our
programs.
The CCHP QMP description will inform internal and external customers about
PURPOSE how CCHP will promote,manage, and document improvement in the quality of
health care and they related services provided to its members, through a
continuous system of planning, monitoring, assessing, and improving.
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SCOPE The scope of CCHP's QMP activities include the quality of clinical care and the
quality of service for all services including, but not limited to, preventive,
primary, specialty, emergency, and ancillary care services. The scope of
activities reflect CCHP's population in terms of age, disease categories and
special risk status, and include, but are not limited to, services provided in
institutional settings, ambulatory care, home care and mental health.
OBJECT • Identify opportunities for improvement through a system of monitoring,
IVES
I which includes satisfaction surveys, complaints, focused studies, facility
inspections, medical-record audits and analysis of HEDIS and administrative
data. Member and community input is considered an integral part of all
I systems of monitoring and shall be incorporated into selection of
i improvement activities through a variety of methods.
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QM Program Description 2006 Page 3 of 22
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• Establish priorities for ongoing monitoring and focused-review studies with
emphasis on access, preventive services, high volume, high risk, or problem-
prone care orl services.
e Confirm that;CCHP delegated providers' Quality Assessment and
Improvement Program structure, staff, and processes are in compliance with
all provisions of CCHP's QM Plan, QM policies and procedures, and meet
professionally recognized standards.
• Comply with�intemal and external standards and requirements related to
quality improvement activities.
• Assure that members can achieve resolution to problems or perceived
problems relating to access to care or other quality issues through Member
i Services and IQM grievance procedures. Members may also communicate
problems or concerns to other regulatory agencies that are outlined in their
Evidence of Coverage booklet.
• Monitor processes and systems of care related to the movement of members
along the continuum of care and ensure continuity of care that meets the
members'needs and expectations.
• Maintain Program Descriptions and/or policies and procedures for all active
Quality Imprbvement Projects (QIPs) and internal quality programs
including Health Education and Cultural and Linguistic Services.
AUTHORITY AND RESPONSIBILITY
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TIIE COI TRA The Contra Costa County Board of Supervisors (BOS) has the ultimate
responsibility for development and implementation of the QMP. The BOS is
COSTA COUNTY responsible for reviewing and approving the QMP on at least an annual basis.
BOARD of The BOS is the lultimate decision-making body for all contract approvals and
SUPERVISORS
terminations, physician disciplinary action, and approval of action taken with
regard to member or physician grievances.
To ensure that action necessary to implement the QMP is taken in a timely
manner, the BOS delegates responsibility for day-to-day operations of CCHP to
i the CCHP Chief Executive Officer(CEO), who, in turn, has empowered the
Joint Conference Committee (JCC) and the Quality Council (QC) to
periodically review and take action, as may be required, with regard to
contracting, physician disciplinary actions, and member and physician
grievances, subject to the BOS' approval.
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QM Program Description 2006 Page 4 of 22
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The Quality Council (QC)has the primary responsibility for implementing and
THE QUTALITY directing the QMP. It is responsible for developing and making
COUNCIL recommendations to the BOS or the JCC regarding quality management
standards, criteria by which care will be measured, and priorities for which
aspects of care will be monitored.
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Reports to the CCHP CEO. The Medical Director is responsible for the
MEDICAL administration and coordination of medical management, including behavioral
DIRECTOR health of CCHP with assistance from the Clinical Operations Officer, a licensed
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registered nurse. The Medical Director, together with medical consultants who
i are licensed physicians, oversees the activities the QM Department, Utilization
Management Department, Cooperative Care Management Department and the
Credentialing Program, including the following:
i • Medical pollicy development
• Clinical practice guidelines
• Medical review and severity leveling of member grievances and
implementing corrective action and/or peer review as appropriate
• Provider education and implementation of disease management and health
promotion programs
• Coordination of physician membership to JCC, QC and Credentialing
Committees
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QM Program Description 2006 Page 5 of 22
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The Clinical Operations Officer(COO) is a registered nurse reporting to the
Medical Director of CCHP. The COO is a member of CCHP's Executive
CLINICAL Committee and co-chairs the Clinical Coordinating Committee with the Quality
OPERATIONS Management Director. The COO assists the Medical Director with
OFFICER coordination of CCHP's clinical programs. Other responsibilities for the COO
include:
• Summarizes clinical issues and reports to the Executive Committee.
• Recommends strategic direction and policy for clinical projects and
programs.
• Guides the clinical activities identified by the Health Plan Coordinating
Committee..
0 Coordinates)the annual audits of delegated providers.
• Guides implementation efforts for clinical programs.
i • Reports clinical activities to other committees as needed, such as the Joint
Conference Committee and the Managed Care Commission.
i • Assists with reviewing data, reporting, developing recommendations, and
iguiding improvement efforts.
• Assists with recommendations and improvement efforts to achieve
appropriate utilization and efficient use allocation of resources.
• Assists the clinical departments to meet regulatory, audit and accreditation
requirements.
• Oversees the Health Education Programs in conjunction with the Director
of Quality Management.
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QM Program Description 2006 Page 6 of 22
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Reports to the CCHP Medical Director. The Director of QM is responsible for
development and implementation of the annual QM Program and the QM
DIRECTOR OF Department operations including:
QUALITY • Compliance)activities for QM regulatory and accreditation requirements.
MANAGEMENT . Development and implementation of disease management initiatives.
• Development and implementation of health education and health promotion
initiatives.
• Development and administration of DHS-required Quality Improvement
Projects. (QIPs).
• Oversight of the QM review for quality of clinical care grievances and
occurrences)
• Oversight of provider on-site facility site review and the corrective action
process in conjunction with provider credentialing and in coordination with
the Medicall Director and Provider Affairs Director.
• Oversight of quality management activities for non-delegated providers, and
contracted delegated providers.
• Development and annual review and revision of QMP description, policies
and procedures.
• Production of HEDIS measures and coordination of the annual HEDIS
audit. l
• Compilation of reports and summaries of recommendations of specific
committees)(set forth in detail below) for presentation to the QC, the JCC,
and to the BOS.
QUALITY MANAGEMENT PROGRAM ACTIVITIES
QM DELEGATION CCHP may delegate all or part of the QM program to a contracted provider
group. Delegated quality monitoring status is granted to contracted providers
upon successful demonstration of the required scope of quality monitoring
activities. Prior to delegation, the contracted provider group's QMP will be
evaluated to assess its ability to carry out required activities.
If CCHP delegates all or part of the QMP, CCHP will develop a written
description of the delegated activities, the delegates' accountability for these
i activities, the frequency of reporting to the plan and the process by which
oversight will be accomplished.
Though CCHP.retains ultimate accountability for quality oversight, quality
management is la shared responsibility between CCHP and its delegated
contracted providers. CCHP's primary delegated providers are CCRMC &
Health Centers land Kaiser Permanente
An annual delegation oversight audit is performed on CCHP's delegates using a
standardized delegated audit tool or other appropriate tool. (Reference
QM14.301).
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QM Program Description 2006 Page 7 of 22
QUALITY Specific qualityl improvement, disease management, health
IMPROVEMENT education/promotion, and culture & linguistics initiatives for 2006 will be
INITIATIVES determined through a collaborative process including CCHP/CCHS clinical and
administrative management staff. Additionally, QM will meet with DHS and
other Local Initiatives to select local and statewide collaborative improvement
projects. Theselprojects are described in detail in the annual QIP reports to the
California Department of Health Services and the annual QM work plan, which
will be finalized by the end of each calendar year and considered an addendum
to the QMP. For year 2006 the 4 DHS required QIPs are
O Asthma
o Diabetes
o Adolescent Health
o Reducing Health Disparities
" Preventive Health Guidelines and Clinical Practice Guidelines for Contra Costa
HEALTH"AND La " `M= Health Plan(CCHP) are developed in collaboration with CCHP's Medical
:CLINICAL-i:_ Po s'x . Director, Medical Consultants, and clinical staff, physicians from the Contra
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y$PRACT CE ';" ' Costa Regional Medical Center/Clinics, and physician representatives from the
Gu1vELrrrrEs q;°:_: Community Provider Network. Guidelines are reviewed every two years and
revised as necessary. Guidelines are distributed to primary care practitioners
and relevant specialists, as well as other appropriate staff.
ANNUAL QM Annually, CCHP will evaluate the effectiveness of its QM programs, activities
PROGRAM and initiatives. The evaluation will be submitted to the QC for input and
EVALU TION approval, generally during the first quarter of each calendar year for the
previous year's lactivities.
QM PROGRAM All these documents are approved by the QC, the JCC, the MCC and BOS
DOCUMENTS • Annual Work Plan
• Program Description
• Program Evaluation
COORDINATION OF CCHP QM PROGRAM ACTIVITIES
QMP activities outside the scope of the QM Department require action from
other departments and administrative divisions. These activities include
credentialing, member grievance processes, utilization management (UM),
advice nurse telephone triage program and care management programs.
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Activities with a significant bearing on quality are linked through QC and
described as follows:
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QM Program Description 2006 Page 8 of 22
CREDENTIALING CCHP has written provider credentialing policies and procedures to review all
new and contracted providers to confirm that all providers have appropriate
practice experience, licensure, certification, hospital privileges, professional
liability coverage, education, and professional and other qualifications to
provide the quality of care consistent with professionally recognized standards,
health plan expectations, and applicable state and federal regulations. Site
visits are conducted, if applicable, for both credentialing and re-credentialing.
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MEMBER Member grievances are received and logged in Member Services. Grievances
GRIEVANCE that raise clinical quality-related issues are referred directly to the QM Unit for
PROCESS review, investigation, tracking, and resolution. The QM Department tracks
quality of care grievances for identifying potential trends. Where appropriate,
system change is recommended or corrective action is implemented. A QM
grievance report and recommendations for remedial action are submitted
quarterly, and more frequently as may be required, to QC. (Reference
MS8.00LM2, MSB.026.MR, MSB.017.C2, QM14.501, QM14.502, QM14.503)
UTILIZATION CCHP's Utilization Management (UM) Program, staffed by actively licensed
MANAGIEMENT registered nurses and non-licensed Medical Record Technicians, oversees the
PROGRAM delivery of health care to members through a process of prospective,
concurrent, and!retrospective review, to determine the appropriateness of health
care services, and to achieve an optimal level of quality. (Reference the UM
Program Description.)
TELEPHONE TRIAGE CCHP's Telephone Triage program, staffed by actively California licensed
PROGRAM Registered Nurses, provides health care advice and education to CCHP
members utilizing the hospital and clinic system, and those county residents
lacking health care coverage. (Reference the Telephone Triage QMProgram
Description and Procedures)
COOPERATIVE CCHP'S Cooperative Care Management Unit (CCM), a hybrid model
CARE i (medical/social and field/telephonic), is staffed by actively licensed registered
MANAGEMENT nurses, clinical asocial workers, and marriage and family therapists. The CCM
PROGRAM Unit employs a.collaborative process that assesses, plans,implements,
coordinates, monitors, and evaluates options and services to meet a client's
health needs thiough communication and available resources to promote quality
outcomes. (Reference the Cooperative Care Management Program Policy and
Procedure Manual)
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HEALTH CCHP'S Health Education Program, staffed by a health education specialist,
EDUCATION oversees and monitors State mandated health education and cultural/linguistic
PROGRAM services through a collaborative process with provider and community
resources that performs needs assessments,planning, development,
i implementation and evaluation. (Reference the Health Education Program
Description)
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QM Program Description 2006 Page 9 of 22
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DISCIPLINARY When a quality Issue or trend is identified and attributed to a specific physician,
ACTIONI and is severe enough to warrant reportable disciplinary action, the Peer Review
and Credentialing Committee (PRCC) will take action in accordance with the
CCHP credentialing appeal process (CR 11.004). In such cases, physicians are
entitled to Judicial Review. The CCHP CEO will arrange for this review
according to the Judicial Review Policy.
SAFETY CCHP demonstrates a commitment to improving safe clinical practice through
IMPROVEMENT • Facility Site Reviews - Medical Record documentation of unsafe environment
ACTIVITIES • Pharmacy—Pieriodic distribution of pharmaceutical updates to providers
CONFIDENTIALITY All quality files and other quality data or information are maintained in a
manner that protects patient and provider confidentiality. CCHP's QM
information is not discoverable or admissible in a court of law as specified in
Section 1157 of the California Evidence Code and Section 1370 of the Health
and Safety Code. All CCHP employees sign a statement of confidentiality upon
employment. CCHP complies with all federal privacy mandates per the Health
Insurance Portability Act of 1996 (HIPPA). Additionally, participants in
CCHP's QC, Credentialing, Peer Review and Grievance committees sign an
additional statement of confidentiality related to the review of medical quality
of care issues.
CONFLICT OF Any individual who has been professionally involved in an issue or case may
INTEREST not participate in the review, evaluation, or final disposition of the case.
QM Program Description 2006 Page 10 of 22
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QM ORGANIZATION CHART
Chief Executive Officer
Rich Harrison
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Medical Director
James Tysell, MD
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Clinical Operations Officer Medical Consultants
Ellen Lent-Wunderlich, SRN Diane Dooley, MD
Troy Kaji, MD
Quality Management Director
Ken Tilly
Health Education I Asthma QIP
--HFacility Site Review Diabetes QIP
HEDIS Adolescent Health QIP
Q01 ality of Care Grievance Management Health Disparities QIP
Cultural and Linguistics Perinatal
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QM Program Description 2006 I Page 11 of 22
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QM(COMMITTEE STRUCTURE
Board of Supervisors
7.
(Joint Conference CCHP Executive Managed Care
Committee Committee Commission
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Health Plan
Coordination _________ Quality Council Quality Customer Resource
Committee
Assurance Relations Management
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Pharmacy and Credentials Appeals
Therapeutic Committee Committee
Committee
BOARD OF SUPERVISORS (BOS)
PURPOSE Contra Costa County Board of Supervisors, which is elected through general
elections, is the governing body of the CCHP. The BOS is ultimately responsible
for development and implementation of the QMP, for contracting, physician
disciplinary action, and action taken with regard to physician and member
grievances
RESPONSIBILITIES o Develops policy in consultation and with the recommendation of the JCC.
o Reviews;evaluates, and acts upon the annual QMP and Work Plan.
0 Reviews,)evaluates, and acts upon QM reports that are submitted at least
quarterly
0 Receives, evaluates and acts upon recommendations of the CCHP
Credential ling Committee.
o Appoints JCC membership.
O Reviews, evaluates, and acts upon findings of the JCC.
MEMBERSHIP Five (5) elecied members through general elections in one of the five districts of
I Contra Costa County for a term of four(4) years.
CHAIR Rotates among the five board members annually
FREQUENCY Weekly public meetings in accordance with the Brown Act. To preserve the
confidentiality of some discussion and reports, the BOS has the authority to meet
in executive session (without any members of the public resent).
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QM Program Description 2006 Page 12 of 22
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JOINT CONFERENCE COMMITTEE (JCC)
PURPOSE The JCC of the BOS and CCHP is the mechanism by which the BOS implements
the QMP and exercises oversight of CCHP. All meetings of the JCC are open to
the public because of the public nature of the BOS.
RESPONSIBILITTES . Promotes communication between the BOS, QC, and CCHP administration.
• Assesses and monitors the overall performance of CCHP and its contracted
providers including, but not limited to, the quality of care and service provided
to members.
• Receives, evaluates, and makes recommendations to the Board regarding the
reports and recommendations of the QC. Such reports include reports
regarding the current and on-going activities of the QM Department and are
made on al quarterly basis or more frequently as may be required.
• Reviews, evaluates, and makes recommendations to the Board, annually or
more frequently as required, regarding modification of the QMP and work
plan, and implementation of the QMP and work plan.
• Receives, evaluates, and takes action with regard to reports from CCHP's QM
Director and Medical Director regarding the current and on-going activities of
the QM Department on a quarterly basis or more frequently as may be
required. Any action taken by the JCC is subject to approval by the BOS.
• Modifies, approves, and implements provider sanctions and contract
terminations. Any action taken by the JCC is subject to approval by the BOS.
• Reviews, evaluates, and acts upon Medical Policy Guidelines, subject to the
BOS' approval.
• Receives and reviews quarterly reports regarding Appeals Committee activity.
• Receives and reviews reports on adherence to Privacy and Confidentiality
regulation's.
1VZEMBP
..ERSHI. The JCC shall not exceed nine (9) total members:
y Voting Privileges
• Two members from the BOS, appointed by the Board.
aTwo physician members appointed by the Board from CCHP delegated and
non-delegated provider networks. To fill these positions, nominations will be
solicited by announcing the vacancy to all providers. The CCHP_Medical
Director will select the candidates andone'=a`1 ma earid p tithe totl
hoard=for.a 'ra,a1 Tern L CU C01 wo` ears ithi unh ited Tea`"=o ntri encs
j_. �_-, '�—Trt'y}t TR IDT[•:^nP.•lvC•.•T'.4.�SS:Y?5 51:;:I^mS:?......,,.e
R=iS c.. a ... :':.: :aw.': !'' y. ro . . :;::.tea is.:Py .^x?ra;,�. zi .
Y
• ,,_quorurrrequires=3 of 4°voting merri ersRiriAattendance;; Tlie rv1=Msicia
alternatem voteiri;''lace_-ofa°physciaiimemberrforofr clung
,.._,
a;guorum'�
Non- Voting Members
• CCHP Medical Director.
• Director of Health Services of Contra Costa County.
• CCHP CEO Executive Director.
QM Program Description 2006 Page 13 of 22
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JOINT ' COI%IMITTEE (JCC)
• Health Services Chief Financial Officer.
• Chair, Managed Care Commission.
CHAIR The Chair is ai member of the BOS, elected annually.
FREQUENCY At least quarterly and are open to the public, except for confidential matters that
may be discussed and acted upon in executive session.
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HEALTH PLAN
COORDINATING '
Pi1RP.OSE The liealth,Plan°Coordir titin Com-mittee_ form to share
. .4.--,<.:.... ter..•
discuss and roblem=sol==ye.clinical and adi irii''stratiue s z = aria,n arise
^: :M+r.:*..:;.:•mak?.:E�:;�.:::.r, '':s_.. ;in•, -
collaboration.toti dep newFandexistmg-`- r.o &ns The''HkbiNe�orts t0AM,S.P.,
xecut veTCornm3ttee The CC:coorcl nates elinMill ams`�k ni a.
F:
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e._.artrrieritsarid=:'s";eclsx _ro pec#sincludirresource.mana` ementdsease
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maria` ementA NEDIS ;advjggj ursesia "ealsaad,- evarie "s cli ucal' rac We
$ a N.:. :R PP ?,
gu deluges fact it 4site�r:,e_vlews >pee .review�l ealth`educat ori°..culture;,and
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r a..:._:..•... , ... _ :'' :�:;:`= - >:��-ter•: :
.,,..,..mow..... .. > ..:.•..._.•.
lIri sties'' ants lon term care"le rsTatiV6,isWes;provider�relations arid:riew
i teclolo es
RESPONSIBILITIES a Recommends strategic direction and policy for clinical and administrative
projects and programs.
• Reviews progress and accomplishments of CCHP projects and programs.
• Facilitates problem solving for CCHP projects and programs.
j • Recommends actions and improvement efforts to achieve appropriate
iutilization and efficient allocation of resources.
• Reviews relevant data, such as HEDIS, and guides improvement efforts.
• Facilitates problem solving for benefit and regulatory projects and programs.
• Assists departments to meet regulatory and accreditation requirements.
• Operationalize new programs throughout CCHP, providing means of
communicating important information across divisional units.
MEMBERSHIP All members are CCHP staff with voting privileges.
• Chief Executive Officer
• Deputy Executive Director
• Clinical Operations Officer
• Quality Management Director
• Medical Director
• Triage Nurse Director
• LWCase Management Director
•
Network Development Coordinator
• Planning Director
• Pharmacy Director
• Long Term Care Integration Project Director
• Director of Marketing and Member Services
•
Compliance Officer
QM Program Description 2006 Page 14 of 22
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HEALTH PLAN COORDINATING '
• Cultural & Linguistic Services Program Manager
• Contracts Manager
• Director of Provider Affairs
• Business,Services Manager
CHAIR Deputy Executive Director
FREQUENCY Monthly I
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THE QUALITY COUNCILI(QC)
PURPOSE The Quality Council (QC) is the principal committee for coordinating and
directing QM activities for CCHP, including but not limited to: quality
management member and provider grievances, peer review and credentialing,
and utilization management
RE:SPONSIB1tiITIES • Receives,1 evaluates, and acts upon the reports of subcommittees.
• Reviews,)evaluates, and makes recommendations to the BOS or the JCC,
annually, regarding the status of contracted providers to whom quality
management, utilization management, credentialing, medical records and
member rights and responsibilities activities have been delegated._
m-•. ^. . .,:..ri�--•.iy:'-�'.rt;�ur.......a� .�.�•:�•%'�''`i.e:. $,�:Y:T.;-`.C.�.5�:.5" "�:..6✓s?�
• Rete%es and eV1ews !at;least; uartezl;::-andnm( re<fre :.06 I ;as re uzred�
reports the Credentialing:�Ctiomrutteeregard%ngthe:cr=edentralisg status
�,...
_.. . _.
�Oi=;�providers.
• ReceivesiQM occurrence and grievance reports, quarterly or more frequently
as required, regarding potential member or provider quality issues. The QC
investigates such occurrence and grievances reports and makes
recommendations to the BOS and the JCC regarding resolution or
implementation of any corrective action that may be required.
•
Receivesl and reviews, at least quarterly and more frequently as required,
reports from the Director of QM regarding unit activities including, but not
limited i to: Quality Improvement projects, Disease Management program status, Health Education, Cultural and Linguistics issues, Facility Site
Review status or issues, occurrence and grievance volume and trends,
delegation audit scores and recommendations. The QC evaluates these
reports and makes recommendations to the BOS and the JCC regarding
implementation of any corrective action that may be required.
• ReceivesIUM reports quarterly or more frequently as required. The QC
evaluates such reports and makes recommendations to the BOS and the JCC
regarding implementation of corrective action that may be required.
• Receives)Grievance Committee activity reports quarterly and more
frequently as required. The QC evaluates such reports and makes
! recommendations to the BOS and the JCC regarding implementation of
corrective action that may be required
• Reviews and makes recommendations to the BOS and the JCC, annually or
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QM Program Description 2006 Page 15 of 22
THE QUALITY COUNCIL(QC)
more frequently as required, regarding modifications to be made to the QM
Work Plan, and other Quality Management reports.
• Reviews and evaluates QM reports pertaining to medical, Pharmacy and
Therapeutics, and benefit interpretation policy issues. The QC makes
recommendations to the BOS and the JCC regarding trends and
modifications to be implemented.
• Distributes QM and other CCHP information to individually contracted
providersl via the Medical Director through letters, newsletters, policies and
procedures, provider manuals, and other appropriate methods.
• Reports to CCHP senior administration for the purpose of planning and
designing services for and administering.CCHP operations.
• Provides additional medical review of appeals/reconsiderations by physician
committee members as required.
• Reviews and approves clinical practice guidelines periodically.
1VIEVLBERSHIP Full VotingPrivile es
• The CCHP Medical Director
• Licensed physician consultant(s) designated by the CCHP Medical Director
• The Quality Chair or designee from each of CCHP's delegated provider
networks
• Director of CCRMC &HC QM Department
• CCRMC I&HC Utilization Review Supervisor
• The CCHP Quality Management Director
• A minimum of two (2) independent physicians from any of the CCHP
icontracted provider networks, with at least one representing the individually
contracted physician network. To fill these positions, nominations are
solicited by announcing the vacancy to all providers. The physician members
will be appointed and annually re-appointed by the CCHP Medical Director.
These members serve one-year terms.
• The CCHP Clinical Operations Officer
• The CCHP Authorizations/Utilization Director
• The CCHP Member Services Manager
• The CCHP Pharmacy Director
• The CCHP Provider Affairs Director
• The CC14P Advice Nurse Manager
Note: For eer review issues, only medical providers may vote.
CHAIR CCHP Medical Director or designee
FREQUENCY Monthly, a minimum of nine (9) times yearly
QM Program Description 2006 Page 16 of 22
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QUALITY COUNCIL SUBCOMMITTEES
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PURPOSE The Credentialing Committee considers CCHP contracted provider credentials
for initial credentialing, re-credentialing, and primary-level appeal disputes. The
Credentialing Committee reports to the QC with recommendations regarding
credentialing'status and disciplinary action, and refers quality related issues to
other appropriate subcommittees as indicated.
RESPONSIBItiTiIES • Receives quarterly reports regarding delegated credentialing actions and
policies.
• Conducts primary appeals of credentialing disputes and makes
recommendations to the BOS or the JCC re arding such a peals.
_ ._..
• 5Re ortsssuesthat, otentialla >m lc`ate' uali f:carei'ssuestof the;''"C or
pther:sub omrnittee5farR:;irivetigatio
.s c n arid'ayn.
Recomrrieridapplcants fq credentialsvor Te credentialirigtathe B;QS.
i Reviews information from the facility site review process and recommends
necessary corrective action
O Considers pertinent grievance and occurrence information as part of the re-
credentialing process and where appropriate notifies the QC or the Medical
Director of potential quality issues that may require intervention.
• Reviews and recommends credentialing policy and procedure modifications
to the QC annually or more fre uently as required.
MEMBERSHIP Full Voting Privileges
o The CCHP Medical Director or designee
o The CCRMC&HC Credentialing Committee Chairperson or designee
o At least two (2) independent physicians from any of the CCHP contracted
providers, with at least one representing the individually contracted
physician network. One of these shall be a primary care physician; the other
shall be a specialty care physician. To fill these positions, nominations are
solicited by announcing the vacancy to all providers. The Medical Director
will select and appoint the most qualified candidates. Members serve at least
one-year(terms.
Non-Voting Members
o The CCHP Director of Provider Affairs
o The QM Department staff who support the committee
o The Credentials unit staff who support the committee
CHAIR The CCHP Medical Director or designee
FREQUENCY Monthly, at a minimum of nine times a year
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QM Program Description 2006 Page 17 of 22
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APPEALS COMMITTEE
PURPOSE The Appeals Committee provides the first level of appeal for all non-urgent
requests for reconsideration of denied, modified or deferred services, and
payment for denied claims and acts as an avenue of member representation
within the CCHP Health Plan. Requests for reconsideration may be received
from members or their legal representative.
The Appeals ICommittee forwards minutes and reports to the QC after each
Committee meeting. Minutes are confidentially maintained by QC for 6 years.
RESPONSIBILITIES . Reviews and determines Requests for Reconsideration of denied claims
' and/or denied, modified or deferred services.
• Reviews and make determinations on appeals for delinquent premium
disenrolhnent
• Reviews requests submitted by a third party, including Medi-Cal Fair
Hearings,' and coordinates CCHP's response, as appropriate.
• Reviews and determines, subject to the Quality Council approval, action to
be taken on complaints against CCHP members which may include plan-
initiated disenrollments.
i0 Considers investigative, administrative matters associated with member
reviews. I
0 Assures that the Member Services Unit confidentially maintains Committee
files for 6 years.
O Acts as the patient advocate within CCHP.
0 Refers issues regarding benefits to the BIM Committee.
o Recommends contract revisions for member materials.
o Recommends quality improvement activities
O Recommends to the QC that suspicious activities be reported to the Fraud
Unit for 'investigation
MEMBERSHIP All members have full voting privileges
The required voting quorum for this committee is at least three Committee
members, once of which must be the Medical Staff M.D. and one clinical member
from Utilization Management.
U Manager of Member Services or designee
o Businessl Services Manager
v Claims Siupervisor or designee's
o Medical Director or Designee Physician Consultant
u Authorizations/Utilization Manager or UM Nurse
v In the specialized case where a medical specialist opinion is warranted, the
specialist will have full voting privileges.
FREQUENCY Meets monthly or ad hoc as needed.
QM Program Description 2006 Page 18 of 22
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PHARMAcv AND THERAkUTICS
COMMITTEE
PURPOSE The Pharmacy and Therapeutics Committee is responsible for the oversight of
drug utilization trends, maintenance of the pharmacy management program, and
ongoing development and oversight of the CCHP drug list. The Pharmacy and
Therapeutics.Committee reports to the QC semi-annually or more frequently as
may be required.
RESP INSIBILITIES • Reviews drug utilization patterns and establishes guidelines and protocols
that help ensure high quality, cost-effective drug therapy.
• Analyzes Inew drugs and determines their status for inclusion in the CCHP
drug list.
• Reviews the drug list and makes additions and deletions as necessary based
on objective pharmaco economic evaluation of their relative therapeutic
efficacy, safety and cost.
• Considers and approves pharmacy prior authorization policies.
• Reports potential clinical issues to the QC for further investigation and
action. I
MEMBERSHIP Voting members
• CCHP Medical Director/designee
• CCHP Pharmacy Director
i • CCRMC Primary Care Physician
• CCRMC Provider-Primary Care
• CCRMC Pharmacist
• CPN Physician
CHAIR The CCHP Medical Director or designee
FREQUENCY Quarterly I
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PUBLIC ADVISORY I& OTHER COORDINATING COMMITTEES
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MANAGED CARE
• •
PURPOSE The Managed Care Commission (MCC) is the principal public advisory board to
CCHP. The goal of the MCC is to help assure the attainment of CCHP's
strategic goals and objectives. The MCC reports directly to the BOS annually
and more frequently as required.
RESPONSIBILITIES • Considerthehealth care concerns for all members served by CCHP.
• Assure provider, consumer, and community, as well as gender, ethnic,
cultural, and geographically diverse population input to deliberations and
decision-making.
• Conduct long-range planning and policy formulation, and make
recommendations to the BOS, County HSD Director and CCHP Chief
Executive Officer(CEO). This includes adopting an annual work plan and
j list of goals and priorities as well as an annual report describing major
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QM Program Description 2006 Page 19 of 22
MANAGED CARE • •
i activities land accomplishments.
• Study and make recommendations to the CCHP CEO regarding operational
objectives, policies and procedures, and recommend changes.
• Assure effectiveness of quality programs by ongoing and periodic review.
• Regularly review the CCHP operational budget and amendments thereto.
• Advise the BOS, HSD Director, and CCHP CEO of the overall progress,
constraining or threatening needs, and special problems of CCHP.
• Encourage public understanding of CCHP and provide support throughout
the county for its development.
• Prioritize)and assign issues to appropriate committees.
• Provide input, including from traditional and safety-net providers, regarding
CCHP's Cultural and Linguistic Services Plan and such reports to the State
as required. This shall include advisement on educational and operational
issues affecting groups who speak a primary language other than English, as
well as cultural competency
MEMBERSHIP There are fifteen (15) commissioners, appointed by the BOS, all with voting
privileges;
• At least one Medi-Cal subscriber
• a Medicare subscriber or beneficiary
• a Commercial subscriber
• an individual sensitive to medically indigent needs
• a non-contracting physician
• at least one other non-contracting provider
• The remaining nine (9) seats are at large members non-contracting with
CCHP. I
Non-voting Members
• The Health Services Director
• CCHP CEO
The BOS serve as ex-officio members without voting privileges.
CHAIR Elected by Commission members The Chair presides at all MCC meetings and
represents the MCC at all CCHP JCC meetings.
FREQUENCY a minimum of six 6) times yearly
MANAGED CARE • • •
The MCC'has an Executive Committee, three standing subcommittees, one
special subcommittee, and Ad Hoc committees.
MEMBERSHIP • MCC Chair
• Vice-Chair
• Immediate past Chair
• Two (2) members elected from the membership as a whole.
v At least one member must be a member of CCHP.
QM Program Description 2006 Page 20 of 22
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COMMISSIONMANAGED CARF
FREQiENCY • "as needed" in compliance with the Brown Act advance written notice
requirements
STANDING Meet for 30 minutes to one hour prior to the scheduled MCC meetings. The
SUBCOMMITTEES subcommittees will make recommendations to the MCC as needed.
• Quality Alssurance: Study health care delivery and new, alternative, or
improved1modes of diagnosis and treatment. Review quality assurance
studies anId reports such as HEDIS. Analyze health education services and
wellness promotion programs. Review disease management plans and
results of iinterventions. Analyze all legislative and regulatory changes that
may impact quality.
• Resource Management: Study plan budgets, expenditures, and cost and
utilization trends. Review resource management efforts including advice
nurse services, care management,pharmacy program, utilization
management, and authorization. Analyze legislative and regulatory changes
with financial impact.
• Customer Relations: Analyze member and consumer issues including
geographic, gender, ethnic, cultural, accessibility, availability, and
acceptability, and other facets of consumer concerns. Examine satisfaction
reports, review outreach and enrollment campaigns and analyze legislative
and regulaltory changes and may impact customers.
SPECIAL • Governance and MCC Operations Committee: Recommend structural and
SUBCOMMITTEES governance changes of the Commission and its standing and special
committees and annually recommend a slate of officers for the MCC. Assist
in MCC member recruitment, orientation, and retention efforts. Make
recommendations to MCC.
• Ad Hoc Committees: There may be Ad Hoc Committees of the MCC. These
will be created by the MCC for special issues or concerns that do not fit into
the work iof the standing committees or that may involve several of them.
j MCC will assign membership and duration of these committees.
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QM Pr(gram Description 2006 Page 21 of 22
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Contra Costa Health Plan
Quality Management Program Description 2006
I
APPROVED BY QUALITY COUNCIL:
Jim TyseKA4DjCommittee Chair I Date I t- 16 -OS
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APPROVED BY THE MANAGED CARE COMMISSION:
Zaa
Lloyd Br's ey, Commission C it Date
APPROVED BY THE JOINT CONFERENCE COMMITTEE
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-, 4- ,�� C• Date
% Gayle,o. Uilkema,.Com' mittee Chair
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APPROVED THE B S
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Date
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QM Program Description 2006 Page 22 of 22
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